Stages Of Dementia Research Articles

Towards data‐driven video analysis for quantification of nocturnal sleep disturbance in dementia

AbstractBackgroundSleep disturbance is common among people living with dementia as well as their caregivers. Non‐contact video technology can be used to characterise such disturbances as well as quantifying sleep quality by measuring the number of sleep body positions (poses). Such an approach may be beneficial for home‐based longitudinal clinical monitoring of sleep pattern changes and disturbances at all stages of dementia. Here we present our pilot results of a personalised data‐driven method applied to video data for quantification of sleep disturbance comparing older and younger participants.MethodData were collected in two separate studies which included an overnight 10‐12 hour laboratory sleep recording from thirteen older (65‐80 years, 9 male:4 female) and eleven younger (18‐34 years, 7 male:4 female) participants in a dedicated sleep facility. A data‐driven analysis using Principal Component Analysis and k‐means clustering was applied to infrared video data extracted from a clinical polysomnography (PSG) system. The data‐driven analysis automatically determined statistically significant groupings or clusters of unique body poses for each individual. Pose number, number of pose transitions, pose duration, and pose transition duration were computed for each participant.ResultThe number of data‐driven poses in older and younger participants was remarkably similar with 15.2±3.9 and 15.8±1.8 (mean±SD) poses per participant, respectively. However, the older group had a higher number of pose transitions (33.0±8.82) compared to the younger group (23.9±6.83) (p = 0.03). A significant 20% difference (p = 0.03) in the average duration of each body position was observed, with 62.3±7.1 minutes and 78.9±15.9 minutes for the older and younger groups, respectively (see Figure 1 and Figure 2). Pose transition duration was 19.2±7.25 seconds and 14.6±4.32 seconds for the older and younger groups, respectively where they were not significantly different.ConclusionAlthough the number of body positions did not vary significantly between the two cohorts, the older group changed body position more frequently and it took them longer to do so. Data‐driven automated analysis of video‐based sleep monitoring holds significant promise for quantifying age‐related and inter‐individual differences in sleep behavior.

Plasma neuregulin 1 as a synaptic biomarker in Alzheimer’s disease

AbstractBackgroundSynaptic dysfunction is an early core feature of Alzheimer’s disease (AD), closely associated with cognitive symptoms. Neuregulin 1 (NRG1) is a growth and differentiation factor with a key role in the development and maintenance of synaptic transmission. Previous reports have shown that changes in cerebrospinal fluid (CSF) NRG1 concentration are associated with cognitive status and biomarker evidence of AD pathology. Plasma biomarkers reflecting synaptic impairment would be of great clinical interest. Our oubjective was to measure plasma NRG1 concentration in AD patients in comparison with other neurodegenerative disorders and neurological controls (NC) and to study its association with cerebrospinal fluid (CSF) core AD and synaptic biomarkers.MethodThis retrospective study enrolled 127 participants including patients with AD at mild cognitive impairment stage (AD‐MCI, n = 27) and at dementia stage (n = 35), non‐AD dementia (n = 26, Aβ‐negative), non‐AD MCI (n = 19) and neurological controls (n = 20). Plasma and CSF NRG1, as well as CSF core AD biomarkers (Aβ 42/Aβ 40 ratio, phospho‐tau and total tau), were measured using ELISA. CSF synaptic markers were measured using ELISA for GAP‐43 and neurogranin and through immunoprecipitation mass spectrometry for SNAP‐25.ResultPlasma NRG1 concentration was higher in AD‐MCI and AD dementia patients compared with neurological controls (respectively P = 0.005 and P<0.001). Plasma NRG1 differentiated AD MCI patients from neurological controls with an area under the curve of 88.3%, and AD dementia patients from NC with an area under the curve of 87.3%. Plasma NRG1 correlated with CSF NRG1 (β = 0.372, P = 0.0056, adjusted on age and sex). Plasma NRG1 was associated with AD CSF core biomarkers in the whole cohort and in Aβ‐positive patients (β = ‐0.197‐ 0.423). Plasma NRG1 correlated with CSF GAP‐43, neurogranin and SNAP‐25 (β = 0.278‐0.355). Plasma NRG1 concentration correlated inversely with MMSE in the whole cohort and in Aβ‐positive patients (all, β = ‐0.188, P = 0.038; Aβ+: β = ‐0.255, P = 0.038).ConclusionPlasma NRG1 concentration is increased in AD patients and correlates with CSF core AD and synaptic biomarkers, and cognitive status. Thus, plasma NRG1 is a promising non‐invasive biomarker to monitor synaptic impairment in AD.

Reconfigured metabolism brain network in asymptomatic microtubule‐associated protein tau mutation carriers: A graph‐theoretical analysis

AbstractBackgroundStudies exploring topologic properties of the metabolic network in the presymptomatic stage of genetic frontotemporal dementia (FTD) are scarce, which may be important for understanding brain function and disease pathogenesis. This study aimed to explore FTD‐specific patterns of metabolism topology reconfiguration in asymptomatic microtubule‐associated protein tau (MAPT) mutation carriers.MethodSix asymptomatic carriers of MAPT P301L mutation were compared with 12 non‐carriers who were all from the same large family of FTD. For comparison, we included 32 behavioral‐variant FTD (bvFTD) patients and 33 unrelated healthy controls. Each participant underwent neuropsychological assessments, genetic testing, and hybrid PET/MRI scan. Voxel‐wise gray matter volume and standardized uptake value ratio were calculated and compared for structural MRI and FDG‐PET, separately. The sparse inverse covariance estimation (SICE) method was applied to topologic properties and metabolic connectomes of brain functional networks derived from 18F‐fluorodeoxyglucose PET/MRI data. Independent component analysis was used to explore metabolic connectivity in the salience (SN) and default mode networks (DMN).ResultThe mean estimated years from symptom onset was 8.33 ± 1.875 years in the mutation carrier group. The asymptomatic MAPT carriers show no significant differences in cognitive tests, gray matter volume and FDG uptake compared to non‐carriers. They also retained normal global parameters of metabolism network, but not for bvFTD patients. However, we revealed lost hubs in the ventromedial prefrontal, orbitofrontal, and anterior cingulate cortices and reconfigured hubs in the anterior insula, precuneus, and posterior cingulate cortex in asymptomatic carriers, which is consistent with the findings in bvFTD patients. Similarly, significant differences in local parameters of these nodes were observed in asymptomatic carriers. The reduction in connectivity was marked in lost hub regions during the asymptomatic stage. Functional connectivity within the SN and DMN was enhanced in asymptomatic carriers, while reduced in bvFTD patients.ConclusionOur findings showed that asymptomatic MAPT carriers were initially involved in medial prefrontal areas and actively compensated in task‐related regions. Topologic properties of the metabolic network may contribute to further investigations and monitoring of the earliest stages of FTD in individuals with genetic backgrounds.

Neuropsychiatric symptom progression in predementia frontotemporal dementia mutation carriers

AbstractBackgroundNeuropsychiatric symptoms (NPS) often occur during the prodromal stage of frontotemporal dementia (FTD), as evidenced by the presence of early psychiatric diagnosis in approximately 50% of bvFTD patients prior to their dementia diagnosis. We hypothesized that carriers of mutations in progranulin (GRN+), chromosome 9 open reading frame 72 (C9orf72+) and microtubule associated protein tau (MAPT+) have increased baseline burden and rates of progression of NPS compared to non‐carrier individuals prior to onset of dementia symptoms based on the Clinical Dementia Rating (CDR) scale.MethodParticipants were recruited through the ARTFL‐LEFFTDS Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Study. NPS were assessed with Neuropsychiatric Inventory‐Questionnaire (NPI‐Q), Geriatric Depression Scale (GDS), Interpersonal Reactivity Index (IRI), Social Behaviour Checklist (SBOCL), and Behavioral Inhibition Scale (BIS) annually for up to five years. We selected participants with CDR scores of 0 and 0.5. If a participant’s CDR changed to above 0.5 during the follow‐up, we only analyzed observations collected before the conversion. We used mixed effects models to compare the baseline burden and the longitudinal progression of NPS measures between carriers and controls, adjusted for baseline age, sex, education, and baseline Montreal Cognitive Assessment (MoCA) scores.ResultWe analyzed data from 607 participants (111 C9orf72+, 47 GRN+, 67 MAPT+ and 382 non‐carrier controls). There were no significant group differences in baseline demographic features, except that MAPT+ was significantly younger than other groups (average age: C9orf72+ = 45, GRN+ = 53, MAPT+ = 41, controls = 54). Baseline NPS scores were not significantly different between carriers and controls, except that C9orf72+ had significantly lower GDS compared to controls (p = 0.002). Longitudinally, GRN+ (p = 0.02) and MAPT+ (p = 0.009) had significantly higher rates of NPI‐Q increases compared to controls, while the progression of NPI‐Q in C9orf72+ was comparable to controls. The rates of GDS, IRI, SBOCL and BIS progression were not significantly different between carriers and controls.ConclusionPrior to the onset of dementia, GRN+ and MAPT+ have a faster progression of NPS, as measured by NPI‐Q, compared to controls. Future work will investigate whether different mutation carriers are affected by specific type/cluster of symptoms.

Testing for acceptance of an assistive social robot for dementia and caregiving

AbstractBackgroundApproximately 5.8 million older adults in the U.S. are living with AD and it is estimated that by 2060, this number is projected to triple. People with AD often require high levels of care and assistance to maintain daily activities. The majority of care provided to a person living with AD or other forms of dementia is from a family caregiver, representing 18.6 billion hours of unpaid care valued at $244 billion. The long duration, time‐intensive nature of caregiving imposes high burdens on caregivers. There is a great need for assistive technologies and innovative solutions for the future of dementia care because of the increasing rise in adults with dementia.MethodA multidisciplinary team of faculty and undergraduate and graduate students was created to design a low‐cost social robot to serve as assistive companions for people with AD. Focus group meetings with caregivers and those with beginning stages of dementia were held, where the team worked in identifying the audience’s needs and robot’s responsibilities. Initial sketches were formulated before being brought to life in Fusion 360 as 3D CAD objects and printed using a 3D printer. Several rounds of iterations of the social robot’s body and user interfaces were created and two final robot designs were tested with undergraduate students (N = 15) for general attitudes of acceptance and feelings of overall experience.ResultResults from our user testing showed that users preferred one design more than another. Users wanted options in their interactions – having the ability to have speech conversation and touch‐screen abilities. Overall, the results from the user testing were positive, and the team is currently working on a final robot design before testing at nursing homes and assisted living facilities.ConclusionEstimated to be less than $300, our socially assistive robot holds promise to help address the disparity issues in the underserved.

Alteration of metabolic profile during the progression of Alzheimer’s disease

AbstractBackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder that threatens the population health of older adults. However, the mechanisms of how altered metabolism involves AD pathology are poorly understood. This study intends to provide novel insights into the role of metabolic alteration in the pathology and identify potential metabolic biomarkers for AD diagnosisMethodThe Gas chromatography‐mass spectrometry (GC‐MS) was used to measure the concentrations of serum metabolites in a cohort of subjects with AD (n = 88) and cognitively normal control (CN) (n = 85). The patients were classified as very mild (n = 25), mild (n = 27), moderate (n = 25), and severe (n = 11). Serum metabolic profiles were analyzed by multivariate (principal component analysis) and univariate approaches (t‐tests, false discovery, receiver operating characteristic curves, and correlation analysis). The artificial neural network model (ANN) was applied to identify potential biomarkers of AD. Biofunctional enrichment analysis was performed using the Kyoto Encyclopedia of Genes and Genomes.ResultThe results revealed considerable separation between the AD and CN patients. Edetic acid, (S)‐3,4‐Dihydroxybutyric acid, and arachidonic acid were identified as potential AD diagnostic biomarkers using an ANN model. And the classification model could predict the risk for AD with high accuracy (AUC = 0.93). The most significant changes in the metabolite’s composition occur during the very mild to the mild stage. The metabolic enrichment analysis revealed that carbohydrate metabolism deficiency and disturbance of amino acids, fatty acids, and lipids metabolism are involved in AD progression. Especially, pathway analysis highlighted that l−glutamate participated in four crucial nervous system pathways (including GABAergic synapse, glutamatergic synapse, retrograde endocannabinoid signaling and synaptic vesicle cycle).ConclusionSerum metabolomic analysis demonstrated that the metabolic alterations had already arisen at the very mild stages of dementia. Disrupt energy metabolism may be the core of the vicious cycle in AD, resulting in a wide range of metabolic disorders, including abnormal glucose metabolism, TCA cycle impairments, amino acids, fatty acids, and lipids dysregulation. Furthermore, a metabolic diagnostic model of AD was constructed using ANN, which could robustly differentiate AD patients from CN. Our study identified new markers for AD diagnosis and highlighted the roles of metabolic changes on the progression of AD.

Tau‐PET imaging with 18F‐PI‐2620 reveals lateralized distribution of tau pathology in critical language regions in patients with early onset of Alzheimer’s Disease and patients with primary progressive aphasia

AbstractBackgroundLanguage disorders are frequent in patients in advanced and early stages of dementia (Goth & Strøm, 2018) together with the deterioration of other cognitive domains (e.g., memory) (Taler & Phillips, 2008). The first complaint in people with dementia often is language impairment, even preceding other cognitive declines (Ferris & Farlow, 2013). Logopenic variant primary progressive aphasia (lvPPA) and non‐fluent/agrammatic variant PPA (nf/avPPA) are rare neurodegenerative disorders being language impairment the main feature (Gono‐Tempini, 2011). Both β‐amyloid (Aβ) and tau appear to occur in Alzheimer disease (AD). Moreover, Aβ and tau aggregates also represent the underlying pathology in lvPPA (Montembeault et al. 2018) while nf/avPPA resembles a pure tau‐pathology. The purpose of this study is to explore the distribution of tau‐pathology in critical language regions in patients with early‐onset AD (EOAD) and patients diagnosed with primary progressive aphasia (PPA).MethodEight participants (55‐77y): 4 with EOAD, 3 with lvPPA (these first seven patients additionally had a positive 18F‐Florbetaben Amyloid PET), 1 with nf/avPPA, and 14 healthy controls (HC) (age range 54‐76y) underwent dynamic PET scans with 18F‐PI‐2620 to examine the distribution of tau‐pathology in the following cortical language regions: inferior frontal gyrus (IFG), superior temporal gyrus (STG), supramarginal and angular gyrus (PL). Group differences in language regions were examined using standardized uptake value ratios (SUVRs) normalized to the inferior gray matter of the cerebellum.ResultCompared to HC, 3/4 patients with EOAD showed elevated levels of 18F‐PI‐2620 binding, mainly in the right IFG and IPL and left STG, while 3/4 patients with PPA (2 lvPPA and 1 nf/avPPA) showed left lateralized elevated uptake of 18F‐PI‐2620 in all language regions. All PPA patients showed increased binding of 18F‐PI‐2620 predominantly in the left parietal regions.ConclusionOur preliminary results reveal a lateralized distribution pattern of 18F‐PI‐2620 in language regions in patients with EOAD and particularly in those with PPA. These findings suggest that 18F‐PI‐2620 PET imaging is a promising tool to visualize tau aggregations in patients with EOAD and PPA. However, further studies are needed to confirm these preliminary results.

Decreased activities of prefrontal and temporal lobes in patients with mild cognitive impairment and mild Alzheimer’s disease on a clock drawing task via functional near‐infrared spectroscopy imaging

AbstractBackgroundStudies have shown that changes in cerebral blood flow occur in the early stage of dementia, including Alzheimer’s disease (AD), and decreased cerebral blood flow contributes to impairment of brain activities, then affects cognitive function. To diagnose AD in very early stage, such as mild cognitive impairment (MCI), it is therefore necessary to find a new way to detect early activities of brain, such as functional near‐infrared spectroscopy (fNIRS).MethodsThe clock drawing task (CLOX) is one of the widely used neurocognitive function scoring test for dementia. In this study, brain activities were examined in patients with MCI (n = 8) and mild AD (n = 8) during an unprompted CLOX drawing using functional near‐infrared spectroscopy (fNIRS). The concentration changes of oxyhemoglobin (HbO), reflecting brain activities indirectly, were tested in each group via fNIRS.ResultsActivation in the right hemisphere was significantly attenuated in mild AD compared with MCI. With the development of disease severity from MCI to mild AD, the reductions of HbO2 concentrations in the right prefrontal and right temporal lobe were observed greater and steeper. The HbO2 in mild AD was significantly lower than that in MCI (false discovery rate corrected, p <0.025). In addition, HbO2 concentration was positively associated with the clinical score of MMSE (MCI group, p<0.05; mild AD group, p<0.05).ConclusionThis study suggests that activity in the frontal and temporal lobes of mild AD is reduced compared to MCI. Those results reflects that CLOX is an effective tool for extracting fNIRS signal features. In addition, fNIRS‐based analysis has great promise for exploring the mechanisms of changes in the sensory‐spatial function of MCI and mild AD.

APOE4 and confluent WMH have a synergistic effect on episodic memory impairment in prodromal dementia

AbstractBackgroundWhite matter hyperintensities (WMH) are a known risk factor for cognitive decline (C.Puzo el. al. 2019). While the ε4 allele of apolipoprotein E gene (APOE4) is another risk factor for cognitive decline in concomitance with WMH (D.Tsuang et. al. 2013), it remains unclear how APOE4 affects the relationship between WMH and cognitive decline, specifically in the prodromal stage of dementia. Our objective was thus to determine how APOE4 moderates the relationship between WMH and cognition in prodromal dementia.Method216 participants with prodromal dementia underwent magnetic resonance imaging (MRI), neuropsychological testing (global and domain‐specific), cardiovascular risk factor assessments and APOE genotyping. Visual ratings for WMH as well as total and lobar WMH volumes were quantified. Moderation analysis was performed to determine the influence of APOE4 on the relationship between WMH and performance on global and domain‐specific cognitive measures (executive function, episodic memory, attention, language) in moderation analysis (Figure 1). The role of confluent and non‐confluent WMH subtype on cognition was additionally studied using moderation analysis and logistic regression (Figure 1).ResultAPOE4 carriers (n = 49) had poorer memory and higher global WMH (p = 0.04), temporal WMH (p = 0.01) and occipital WMH (p = 0.02) compared to APOE4 non‐carriers (n = 167). APOE4 strengthened the relationship between higher total WMH burden and worse episodic memory performance (Fig.2a). At the lobar WMH level, APOE4 strengthened associations between frontal, temporal, parietal and occipital WMH and episodic memory performance (Fig.2b, Fig.2c, Fig.2d, and Fig.2e) with large sized effects (β). APOE4 did not interact with either total or lobar WMH to predict worse cognition in other cognitive domains. Moreover, APOE4 strengthened the relationship between frontal WMH with episodic memory in the confluent WMH subgroup (Fig.2f). Logistic regression model showed memory impairment was 4.81 times more likely to develop in patients carrying APOE4 and with confluent WMH compared to APOE4 non‐carriers and those with non‐confluent WMH (OR 4.81, β 1.57, p<0.01).ConclusionThe impact of WMH on memory may be strongest in APOE4 carriers at the prodromal dementia stage. Clinicians targeting WMH would need to consider the APOE4 allele and WMH severity status to strategize cognitive interventions.

Elevated oxidative stress and inflammatory levels are associated with plasma AD biomarkers in middle‐age

AbstractBackgroundNeuroinflammation and oxidative stress (OS) are implicated in the pathophysiology of Alzheimer’s disease (AD). However, the extent to which inflammation is attributable to disease progression in the central nervous system in the pre‐ and clinical stages of dementia or emerges in the periphery and is a long‐term risk factor for the development of the pathological hallmarks of dementia is an unresolved question.MethodInflammatory (TNFa, TNF‐R1, TNF‐R2, IL1b, IL4, IL6, IL8, IL10), OS (NO, NEO, TAC), OS‐related DNA damage markers, and total tau, amyloid β1‐38 (Aβ38), amyloid β1‐40 (Aβ40), amyloid β1‐42 (Aβ42) levels were measured in plasma using highly sensitive immunoassays. Inflammatory and OS states were identified through principal component analysis. Associations between inflammatory/OS states and AD biomarkers were investigated in middle‐age (52‐56 years, n = 335, 52% female) and older‐age (72‐76 years, n = 351, 46% female) participants without dementia through linear regression analyses while controlling for relevant covariates.ResultFour similar principal components reflecting different inflammatory states (PC1: unspecific increased inflammation; PC2: inflammation related to anti‐oxidant activity; PC3: increased OS activity with DNA damage; PC4: decreased OS and increased anti‐oxidant activity with DNA damage) were detected in the two age samples. In middle‐age, a component reflecting variation in OS (PC4) was most strongly associated with tau and to a lesser extent amyloid‐b levels. In older‐age, a similar component to that observed in middle‐age was only associated with tau, while another (PC1) component reflecting heightened inflammation independent of OS, was associated with all AD biomarkers.ConclusionIn middle and older age community‐living individuals without dementia inflammation and OS states are already associated with plasma AD biomarkers. The fact that more consistent and robust associations with AD biomarkers involved OS, or OS‐related DNA damage suggests that oxidative stress may be a particularly strong contributor to early AD pathophysiology and requires more systematic investigation.

What a single electroencephalographic (EEG) channel can tell us about Alzheimer's disease patients with mild cognitive impairment

AbstractBackgroundAbnormalities in the neurophysiological oscillatory mechanisms generating dominant resting‐state eyes closed electroencephalographic (rsEEG) rhythms portray the Alzheimer’s disease (AD) continuum, from the preclinical to the dementia stage. Here, we tested whether these abnormalities may be reproducible by analyzing the rsEEG signals acquired in bipolar configuration with a montage consisting of only four centro‐parietal and parieto‐occipital channels (C3‐P3, C4‐P4, P3‐O1, and P4‐O2) in patients with mild cognitive impairment (MCI) due to AD (ADMCI).MethodTo evaluate the study hypotheses, clinical, neuropsychological, anthropometric, genetic, cerebrospinal fluid (CSF), MRI, and rsEEG data in 70 Nold and 75 ADMCI subjects from an international archive were used in the present study. The subgroups were matched for age, gender, and education. In all subjects, rsEEG recordings lasted about 3‐5 minutes. The rsEEG data were recorded with a sampling frequency of 128‐512 Hz and related antialiasing bandpass between 0.01 Hz and 60‐100 Hz. Electrode montage included 19 scalp monopolar sensors placed following 10‐20 System. The rsEEG rhythms were investigated at individual delta, theta, and alpha frequency bands as well as fixed beta (14‐30 Hz) and gamma (30‐40 Hz) bands.ResultResults confirmed previous evidence about the abnormalities of the delta, theta, and alpha rhythms in ADMCI patients compared to Nold subjects. Moreover, as compared to the Nold group, the ADMCI group showed increased delta power density and decreased alpha power density at the C3‐P3, C4‐P4, P3‐O1, and P4‐O2 bipolar channels. Increased theta power density for ADMCI patients was observed only at the C3‐P3 bipolar channel. Best classification accuracy between the ADMCI and Nold individuals reached 81% (area under the receiver operating characteristic curve) using Alpha2/Theta power density computed at the C3‐P3 bipolar channel.ConclusionThe current findings provide evidence in the potential use of rsEEG low‐channel portable devices as a topographic biomarker of cognitive decline within the extensive screening of in elderly population at risk of developing AD‐ or other dementia‐related disorders. Moreover, the confirmation of this hypothesis would have exciting applications in the framework of telehealth home monitoring of global brain functions.

Narrative design for dementia care: Arranging the built environment of care homes to aid communication

AbstractBackgroundThe built environment has been shown to have significant potential to improve the quality of life and contribute to the well‐being of persons living with dementia. Persons with dementia in residential care suffer from isolation as it is difficult for staff and family members to find common routes of communication when the disease progresses. Within dementia care there is an urgent need to further facilitate communication especially with people living with late stage dementia. Storytelling has been effectively used in art therapy and art interventions for people affected by dementia to enhance communication, social connectivity and well‐being.This presentation explores the possibilities of incorporating a novel type of environmental design in care homes that would enhance narrative agency in residents with dementia thus allowing residents, caregivers and staff members to communicate through storytelling.MethodsDrawing on interdisciplinary research, the primary focus of the presentation is a case study examining the implementation of storytelling design in residential care settings. The case study reports on the co‐creation of a space focused on offering lived experiences for residents with dementia in a London care home highlighting design elements that trigger storytelling and stimulate imagination. Such elements include sensory wall surfaces, furniture, soft furnishings, configuration of space and inclusion of technology. The presentation explores whether this type of design could provide routes of communication between residents, staff and family members thus improving the quality of life of people living with dementia.ResultsBased on this case study example, the presentation discusses the value and impact of appropriate storytelling design on the wellbeing of people with dementia and their carers, and future avenues for improving the physical environment in care homes based on narrative design possibilities.ConclusionThere is a possibility for a significant impact of narrative design to communication, social connectivity and well‐being of people living with dementia.

The time-dependent impact of type 2 diabetes mellitus on incident prodromal Alzheimer's disease: a longitudinal study in 1395 participants.

To investigate the longitudinal impact of type 2 diabetes mellitus (T2DM) on the prodromal and dementia stages of Alzheimer's disease (AD), focusing on diabetes duration and other comorbidities. 1395 dementia-free individuals aged 55-90 years with a maximum 15-year follow-up data were enrolled from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of the incidence of prodromal or dementia stages of AD. Longer T2DM duration (≥5 years) (multi-adjusted HR=2.19, 95% CI=1.05-4.58), but not shorter T2DM duration (<5 years), was associated with a significantly increased risk of incident prodromal AD over a mean follow-up of 4.8 years. APOE ε4 alleles (HR=3.32, 95% CI=1.41-7.79) and comorbid coronary artery disease (CAD) (HR=3.20, 95% CI=1.29-7.95) further increased the risk of incident prodromal AD in patients with T2DM. No significant association was observed between T2DM and conversational risk of progression from prodromal AD to AD dementia. T2DM, which is characterized by a longer duration, increases the incidence risk of prodromal AD but not AD dementia. APOE ε4 allele and comorbid CAD strengthen the relationship between T2DM and prodromal AD. These findings highlight T2DM characteristics and its comorbidities as predictors for accurate prediction of AD and screening of at-risk populations.

Dignity of individuals with dementia, palliative care, and futile treatment

Abstract Case studies are used to reflect on the treatment of patients with dementia hospitalized at the Geriatric Department of the Faculty hospital in Prešov, emphasizing human dignity in clinical practice. The discussion is focused on the palliative care of patients with severe dementia. The biomedical method, which respects human dignity is defined by means of inductive, deductive, and normative bioethical methods. They make it possible to provide guidelines for palliative care and individualized prognosis strategy. An analysis of health status of individuals with severe dementia enables us to offer a clinical definition of purposeful treatment based on normative justice and decision-making that reflects the patient’s best interest, thus respecting their dignity. An evaluation of a patient’s care is based on a biomedical method that considers the dementia stage. Applying a bioethical model in a holistic context preconditions the human rights of patients with dementia.

Community-based early dementia advance care planning in the United States: A scoping review

• Advance care planning conversations empower shared decision-making among persons living with dementia. • Community-based advance care planning during the early stages of dementia may prevent avoidable care and promote quality of life. • Standard and skillful communication by providers with consideration of social determinants of health may support early dementia advance care planning. • Nurses are ideally situated to facilitate caregiver engagement and promote community-based early dementia goals of care conversations.

Wearable devices: underrepresentation in the ageing society

Wearable devices: underrepresentation in the ageing society

Discrepancies in dyadic coping: associations with distress and quality of life in couples facing early stage dementia.

Due to an aging population, the number of persons living with dementia (PWDs) is increasing worldwide. Romantic partners, as informal caregivers (IC) of PWDs, are often adopting additional tasks. The concept of dyadic coping (DC) addresses how couples cope with stress together. For dyadic coping to be successful, efforts of both partners should be equal. The current study examines how discrepancies in PWDs and ICs perspectives on DC relate to distress and quality of life in each partner within couples facing early stage dementia (ESD). A total of 37 mixed-sex couples including one partner with ESD completed self-report questionnaires. Discrepancies in reciprocity (comparing provided or received levels of DC between partners), equity (each partner balancing own levels received and provided), and congruence (the agreement about levels of DC exchanged between partners) and their covariation with distress and quality of life (QoL) of each partner were measured. Both partners indicated a discrepancy in reciprocity: PWDs reported receiving more DC than ICs reported receiving, which was associated with higher QoL in PWDs and lower QoL in ICs. Inequities were found in ICs only, who reported receiving less DC, than providing. No relation between inequities and distress or QoL was found. ICs reported more incongruencies than PWDs did, which was associated with higher QoL and less depression in partners. A redivision of tasks and roles in the early stage of dementia is associated with different experiences and views between partners. Whereas ICs take over most household and care tasks within the couple, their effort was considered less helpful by PWDs than by ICs. A high care burden is associated with a compromised quality of ICs' social life and living conditions. The clinical implications of the results are discussed.

Factors influencing access to nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia: An integrative review.

Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions. The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia. An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.

Towards a future where Alzheimer's disease pathology is stopped before the onset of dementia.

Alzheimer's disease (AD) is a major healthcare challenge with no curative treatment at present. To address this challenge, we need a paradigm shift, where we focus on pre-dementia stages of AD. In this Perspective, we outline a strategy to move towards a future with personalized medicine for AD by preparing for and investing in effective and patient-orchestrated diagnosis, prediction and prevention of the dementia stage. While focusing on AD, this Perspective also discusses studies that do not specify the cause of dementia. Future personalized prevention strategies encompass multiple components, including tailored combinations of disease-modifying interventions and lifestyle. By empowering the public and patients to be more actively engaged in the management of their health and disease and by developing improved strategies for diagnosis, prediction and prevention, we can pave the way for a future with personalized medicine, in which AD pathology is stopped to prevent or delay the onset of dementia.

Change in the Quick Dementia Rating System Across Time in Older Adults with and without Cognitive Impairment.

The Quick Dementia Rating System (QDRS) is a brief, informant-reported dementia staging tool that approximates scores on the Clinical Dementia Rating Scale in patients with Alzheimer's disease (AD). The current study sought to examine change in the QDRS across time, which is necessary for clinical and research efforts. One-hundred ten older adults (intact, mild cognitive impairment [MCI], mild AD, classified with Alzheimer's Disease Neuroimaging Initiative criteria) were rated on the QDRS by an informant and had an amyloid positron emission tomography scan at baseline. The informant re-rated each participant on the QDRS after one year. Dependent t-tests compared the entire sample and various subgroups (e.g., cognitive status, amyloid status) on baseline and follow-up QDRS scores. In the entire sample, the Total score on the QDRS significantly increased (i.e., worsened) on follow-up (p < 0.001). When subgroups were analyzed, the MCI and mild AD subjects showed increasing (i.e., worsening) QDRS Total scores (both p < 0.001), but the intact subjects remained stable over time (p = 0.28). Additionally, those classified as being amyloid positive at baseline showed significantly increased QDRS Total scores at follow-up (p < 0.001) compared to those who were amyloid negative at baseline, whose QDRS Total scores remained stable over time (p = 0.63). The QDRS can potentially demonstrate worsening functioning status across one year, especially in those who have MCI or mild AD and those who are amyloid positive. Therefore, the current results preliminarily suggest that the QDRS may provide an efficient tool for tracking progression in clinical trials in AD.